HIV and Health System Strengthening in Fragile States: Improving HIV Prevention, Care and Treatment

AIDS 2012 Fragile States panel

Panelists at the session HIV and health system strengthening in fragile states, July 26 at AIDS 2012 conference. (Photo credit: S. Holtz/MSH)

MSH in collaboration with the International Rescue Committee (IRC) and Physicians for Human Rights (PHR) sponsored a lively satellite session at the XIX International AIDS Conference in Washington DC discussing, “What are the keys to working on HIV & AIDS in fragile states?” Moderated by Susannah Sirkin of PHR, the session included an exciting interchange among panelists and delegates in the audience.

MSH President Dr. Jonathan Quick led off the discussion with a number of observations on fragile states, which included the point that a state which is not functioning effectively, (inadequate services, high levels of violence, etc.) — regardless of the cause — could be considered fragile. Each fragile state is unique, but all face similar challenges in that access to health services is difficult; often the population, at least in certain regions, must cope with considerable violence and insecurity.

The panelists, Peter Mutanda and Aminul Islam of IRC and I, contributed insights into the many vexing questions posed by dealing with HIV in fragile states where governments and society are overwhelmed by other problems and challenges that at times seem to dwarf the issue of HIV. In some fragile states, the prevalence of HIV is relatively low. These countries need to balance the immediate crises they face and the large numbers of preventable maternal and child deaths with the need to deal with HIV now to forestall a more serious epidemic down the road.

Members of the audience brought up fascinating examples of work that NGOs and ministries have done trying to deal with HIV in such fragile states as Democratic Republic of the Congo and Somalia. The discussion included these key issues:

  • What can we learn from fragile states where, despite overwhelming problems, some health programs are effective?
  • How should fragile states prioritize HIV amid other concerns?
  • What should be done when data are poor or non-existent?  How high a priority should fragile states place on obtaining better epidemiologic and surveillance data versus other pressing needs?
  • In fragile states where donors provide most health funding, how can country ownership of health programming be obtained? Who is ultimately responsible for deciding on health priorities, given the fact that ministries of health in many fragile states are barely functioning?

While we didn’t necessarily provide answers to these challenging questions, the discussion was stimulating and thoughtful for all who attended — and gave all of us a lot to think about as we return to work on strengthening health systems for HIV in fragile states.

Steve Solter, MD, MPH, is MSH’s country lead and technical lead on fragile states. MSH is currently working with partners in several fragile states, including South Sudan, Democratic Republic of the Congo, Afghanistan, Haiti, and Liberia.

 

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